Outcome of Liver Transplantation for Drug-Induced Acute Liver Failure in the United States: Analysis of the United Network for Organ Sharing Database
Outcome of Liver Transplantation for Drug-Induced Acute Liver Failure in the United States: Analysis of the United Network for Organ Sharing Database
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DOI：
10.1002/lt.21692
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发表时间：
2009-07-01
影响因子：
4.6
通讯作者：
Regev, Arie
中科院分区：
文献类型：
--
作者：
Mindikoglu, Ayse L.;Magder, Laurence S.;Regev, Arie
急性肝衰竭（ALF）是一种罕见但可能致命的药物相关不良反应，通常导致肝移植（LT）或死亡。使用器官共享标准移植分析和研究联合网络文件进行回顾性队列研究。对1987年至2006年因药物性急性肝衰竭（DIALF）接受LT的患者进行了分析。共有661例DIALF移植患者纳入分析。4个主要涉及药物组为对乙酰氨基酚（n = 265; 40%）、抗结核药物（n = 50; 8%）、抗癫痫药物（n = 46; 7%）和抗生素（n = 39; 6%）。对乙酰氨基酚、抗结核药、抗癫痫药、抗生素和其他药物的一年估计生存概率分别为76%、82%、52%、82%和79%。在接触抗癫痫药的患者中，观察到存活率较低的主要是儿童。在22名18岁以下因抗癫痫药物而发生ALF的患者中，73%在第一年内死亡。对乙酰氨基酚相关和非对乙酰氨基酚相关ALF之间的总生存率差异无统计学意义。对乙酰氨基酚相关的ALF患者在LT前需要透析的比率显著高于所有其他药物组（27%对3%-10%，P < 0.0001）。根据考克斯比例风险回归分析，移植前LT后死亡的独立预测因素是正在接受生命支持，18岁以下抗癫痫药物导致的DIALF和血清肌酐升高。总之，在美国，由DIALF引起LT的主要药物组是对乙酰氨基酚、抗结核药、抗癫痫药和抗生素。与其他药物相比，因抗癫痫药物而发生ALF的儿童在LT后死亡的风险明显更高。因对乙酰氨基酚相关ALF而接受移植的患者需要透析的比率明显更高。在生命支持，DIALF由于抗癫痫药（在18岁以下），血清肌酐升高是独立的移植前预测因子的DIALF LT后生存率差。肝移植15：719-729，2009. (C)2008年AASLD。
Acute liver failure (ALF) is an uncommon but potentially lethal drug-related adverse effect that often leads to liver transplantation (LT) or death. A retrospective cohort study was performed with the United Network for Organ Sharing Standard Transplant Analysis and Research files. Recipients who underwent LT for drug-induced acute liver failure (DIALF) from 1987 through 2006 were analyzed. A total of 661 patients transplanted for DIALF were included in the analysis. The 4 leading implicated drug groups were acetaminophen (n = 265; 40%), antituberculosis drugs (n = 50; 8%), antiepileptics (n = 46; 7%), and antibiotics (n = 39; 6%). One-year estimated survival probabilities were 76%, 82%, 52%, 82%, and 79% for acetaminophen, antituberculosis drugs, antiepileptics, antibiotics, and others, respectively. The lower rate of survival among those exposed to antiepileptics was observed mainly in children. Of the 22 patients less than 18 years old who had ALF due to antiepileptics, 73% died within the first year. The difference in overall survival between acetaminophen-related and non-acetaminophen-related ALF was not statistically significant. Patients with acetaminophen-related ALF required dialysis prior to LT at a significantly higher rate than all other drug groups (27% versus 3%-10%, P < 0.0001). According to Cox proportional hazards regression analysis, the independent pretransplant predictors of death after LT were being on life support, DIALF due to antiepileptic drugs at age less than 18, and elevated serum creatinine. In conclusion, the leading drug groups causing LT due to DIALF in the United States were acetaminophen, antituberculosis drugs, antiepileptics, and antibiotics. Children who had ALF due to antiepileptics had a substantially higher risk of death after LT in comparison with other drugs. Patients transplanted for acetaminophen-related ALF required dialysis at a significantly higher rate. Being on life support, DIALF due to antiepileptics (at age less than 18), and elevated serum creatinine were independent pretransplant predictors of poor survival after LT for DIALF. Liver Transpl 15:719-729, 2009. (C) 2008 AASLD.